1. MODULE 4: KNOWLEDGE APPLICATION Unit 6: Intersectoral Approach Elaborated by: Amets Suess, Andalusian School of Public Health, 2015

2. Presentation: “Intersectoral Approach” Activity: “Mapping an Intersectoral Action” Outline of the Session

3. Intersectoral Action: Concept Intersectoral action for health could be defined as a coordinated action that explicitly aims to improve people’s health or influence determinants of health. Intersectoral action for health is seen as central to the achievement of greater equity in health, especially where progress depends upon decisions and actions in other sectors. (Ståhl, et al. 2006) Ståhl, et al. 2006; WHO, Public Health Agency of Canada 2008. [W]e understand “intersectoral action for health” to refer to actions undertaken by sectors outside the health sector, possibly, but not necessarily, in collaboration with the health sector, on health or health equity outcomes or on the determinants of health or health equity. (WHO, Public Health Agency of Canada 2008: 2)

4. Intersectoral Action: Conceptualization Intersectoral action is conceptualized as related to: Models of health inequities and social determinants of health. “Health in All Policies” framework. Different levels of development and application. Participation of multiple institutions and stakeholders.. Health in All Policies (HiAP) is a policy strategy which targets the key social determinants of health through integrated policy responses across all relevant policy areas. (CHAFEA 2014: 21) CHAFEA 2014; Marmot 2013; McQeen et al. 2012; Ministry of Health and Social Policy of Spain 2010; Ståhl, et al. 2006; Vervoordeldonk, et al. 2013; WHO 2008, 2010, 2011.

5. Intersectoral Action: Opportunities and Limitations Opportunities Development of synergies. Achievement of intersectoral co-benefits. Enhancement of equity in health. Reduction of geographical inequalities. Limitations Difficulties in the coordination among stakeholders. Costs of intersectoral interventions. Difficulties in measuring cost-benefits balance. Limited implementation on a local level due to a reduced priorization at a European, national or regional level. Difficulties in the improvement of social determinants of health. CHAFEA 2014; Marmot 2013; McQeen et al. 2012;; Ministry of Health and Social Policy of Spain 2010; Ståhl, et al. 2006; Vervoordeldonk, et al. 2013; WHO 2008, 2010, 2011.

6. Intersectoral Action: Strategies  Improving a political and institutional recognition of intersectoral action.  Including long-term perspectives.  Assuring continuity, assessment and follow up.  Promoting community participation and empowerment.  Adapting intersectoral actions to the political, economic and cultural context. CHAFEA 2014; Marmot 2013; McQeen et al. 2012;; Ministry of Health and Social Policy of Spain 2010; Ståhl, et al. 2006; Vervoordeldonk, et al. 2013; WHO 2008, 2010, 2011.

7. Intersectoral Action: Relevance within Health Inequalities Actions Revision of 64 actions addressing health inequalities conducted within the EU First and Second Health Programme “Health in All Policies (Intersectoral Action)” as the less frequent type of intervention. Increasing consideration of intersectoral actions in the EU Second Health Programme. Migrants and ethnic minorities as a relevant target group. Figures and data: CHAFEA 2014: 22, 24.

8. Intersectoral Action: Relevance for Health Care and Health Policies Addressed to Migrants and Ethnic Minorities Multi-sectoral dimension of migrant and ethnic minorities health: Economic, political and social character of the determinants of migrants’ and ethnic minorities’ health. Contribution of integrated, intersectional, multivariate and multilevel approaches to improve understanding of health inequities and resources for tackling them. Relevance of regional and international partnerships. Importance of an involvement of civil society organizations. Ingleby 2012; WHA 2008a, 2008; WHO 2010.

9. Intersectoral Action Recommendations Recommendations related to intersectoral action and “Health in All Policies” Promotion of intersectoral actions, cross-sectoral strategies and “Health in All Policies”. Mainstreaming focus on health inequalities instead of limitation of actions on specific vulnerable groups. Consideration of the social determinants of the migrants’ and ethnic minorities’ health in developing intersectoral actions. Intersectoral actions focused on addressing the impact of the current economic crisis on health care and health. Monitoring and ongoing assessment of intersectoral actions. CHAFEA 2014; Marmot 2013; McQeen et al. 2012; Ministry of Health and Social Policy of Spain 2010; Ståhl, et al. 2006; Vervoordeldonk, et al. 2013; WHA 2008a, 2008b; WHO 2008, 2010, 2011.

10. Constructing an Intersectoral Action Plan Migrants and Ethnic Minorities Health Identification of the need of intersectoral collaboration CIMAS 2009; Community Tool Box 2014; RedIsir 2014; Risler et al. 2013. Transmission of the idea to other sectors and stakeholders Mapping of relevant stakeholders and existing resources Intersectoral action plan SWOT analysis (Strengths, weeknesses, opportunities and threats) Preparation of interventions Actions and interventions Assessment of results Exchange of experiences, expectations and objectives Preparation Situational Analysis Implementation Assessment Improvement of actions and interventions PlanningIdentification of intervention methodologies

11. Activity Mapping an Intersectoral Action. Methodology: CIMAS 2009; CommunityToolBox 2014; Risler et al. 2013. In small groups: Describe an intersectoral action related to the health of migrants and ethnic minorities existing in your own institutional, local, regional or national context. Construct a map of relevant stakeholders and resources for the intersectoral action. Draft the existing interactions and barriers between stakeholders. Create a future picture of an ‘ideal’ intersectoral coordination. Identify strategies to achieve the ‘ideal’ picture. In the plenary: Wrap up and discussion.

12. Thank you and questions … Pictures: Andalusian Childhood Observatory (OIA, Observatorio de la Infancia de Andalucía) 2014; Josefa Marín Vega 2014; RedIsir 2014; Morguefile 2014.

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International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, 1990, n.p. http://www2.ohchr.org/english/bodies/cmw/cmw.htm (consultado: 5 de marzo de 2015).http://www2.ohchr.org/english/bodies/cmw/cmw.htm UN, United Nations. International Covenant on Economic, Social and Cultural Rights, 1966 [1976]. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx (consultado: 5 de marzo de 2015). http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx UNESCO, United Nations Educational, Scientific and Cultural Organization. Intercultural Competences. Conceptual and Operational Framework. Paris: UNESCO, 2013. http://unesdoc.unesco.org/images/0021/002197/219768e.pdf (consultado: 5 de marzo de 2015). http://unesdoc.unesco.org/images/0021/002197/219768e.pdf UNESCO, United Nations Educational, Scientific and Cultural Organization. UNESCO Universal Declaration on Cultural Diversity. 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Geneva: WHO, 2008. http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf (consultado: 5 de marzo de 2015). http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf WHO, World Health Organization. A conceptual framework for action on the social determinants of health. Discussion Paper Series on Social Determinants of Health 2. Geneva: WHO, 2010. http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf (consultado: 5 de marzo de 2015). WHO, World Health Organization. WHO Global Strategy on People-Centred and Integrated Health Services. Geneva: WHO, 2014. http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ (consultado: 5 de marzo de 2015).http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ WHO, World Health Organization. WHO’s Contribution to the World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance. Health and freedom from discrimination. Health & Human Rights Publication Series Issue No. 2, Geneva: WHO, 2001. http://www.who.int/hhr/activities/q_and_a/en/Health_and_Freedom_from_Discrimination_English_699KB.pdf http://www.who.int/hhr/activities/q_and_a/en/Health_and_Freedom_from_Discrimination_English_699KB.pdf (consultado: 5 de marzo de 2015). Woodward A, Howard N, Wolffers I. Health and access to care for undocumented migrants living in the European Union: a scoping review. Health Policy and Planning 2014;29:818-830. World Health Assembly. WHA 61.17 Health of Migrants, 24 May 2008. http://apps.who.int/gb/ebwha/pdf_files/A61/A61_R17-en.pdf (consultado: 5 de marzo de 2015). http://apps.who.int/gb/ebwha/pdf_files/A61/A61_R17-en.pdf UN, United Nations. 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